Emergence of multidrug-resistant Salmonella enterica serotype typhimurium DT104 infections in the United States

N Engl J Med. 1998 May 7;338(19):1333-8. doi: 10.1056/NEJM199805073381901.


Background: Strains of salmonella that are resistant to antimicrobial agents have become a worldwide health problem. A distinct strain of Salmonella enterica serotype typhimurium, known as definitive type 104 (DT104), is resistant to ampicillin, chloramphenicol, streptomycin, sulfonamides, and tetracycline and has become a major cause of illness in humans and animals in Europe, especially the United Kingdom.

Methods: To characterize typhimurium DT104 infections in the United States, we analyzed data collected by local and state health departments and public health laboratories between 1979 and 1996 in national surveys of the antimicrobial-drug resistance of salmonella. Selected typhimurium isolates with the five-drug pattern of resistance were phage typed.

Results: The prevalence of typhimurium isolates with the five-drug pattern of resistance increased from 0.6 percent in 1979-1980 to 34 percent in 1996. In 1994-1995, such isolates were identified in samples from 36 of the 46 surveillance sites (78 percent). Thirty-nine of 43 typhimurium isolates with the five-drug pattern of resistance identified in 1994-1995 and 1996 were phage type DT104 or a closely related phage type.

Conclusions: Multidrug-resistant typhimurium DT104 has become a widespread pathogen in the United States. More prudent use of antimicrobial agents in farm animals and more effective disease prevention on farms are necessary to reduce the dissemination of multidrug-resistant typhimurium DT104 and to slow the emergence of resistance to additional agents in this and other strains of salmonella.

MeSH terms

  • Drug Resistance, Multiple*
  • Humans
  • Population Surveillance
  • Prevalence
  • Salmonella Infections / epidemiology*
  • Salmonella Infections / microbiology*
  • Salmonella enterica / classification*
  • Salmonella enterica / isolation & purification
  • Serotyping
  • United States / epidemiology